title: When a patient declines curative care: management of a ruptured aortic aneurysm.
abstract: The management of major vascular emergencies in the emergency department (ED) involves rapid, aggressive resuscitation followed by emergent definitive surgery. However, for some patients this traditional approach may not be consistent with their goals and values. We explore the appropriate way to determine best treatment practices when patients elect to forego curative care in the ED, while reviewing such a case. We present the case of a 72-year-old patient who presented to the ED with a ruptured abdominal aortic aneurysm, but refused surgery. We discuss the transition of the patient from a curative to a comfort care approach with appropriate direct referral to hospice from the ED. Using principles of autonomy, decision-making capacity, informed consent, prognostication, and goals-of-care, ED clinicians are best able to align their approach with patients' goals and values.
authors.affiliation: Rutgers, The State University of New Jersey, New Jersey Medical School, Newark, New Jersey.
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Lamba
authors.forename: Megan
authors.initials: M
authors.lastname: Bonanni
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Courage
authors.forename: Roxanne
authors.initials: R
authors.lastname: Nagurka
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Zalenski